Invasiveness of previous treatment for peripheral arterial disease and risk of adverse cardiac events after coronary stenting

Tineke H Pinxterhuis; Clemens von Birgelen; Robert H Geelkerken; Carine J M Doggen; Theo P Menting; K Gert van Houwelingen; Gerard C M Linssen; Eline H Ploumen

doi:10.1007/s12928-024-00986-7

Invasiveness of previous treatment for peripheral arterial disease and risk of adverse cardiac events after coronary stenting

Cardiovasc Interv Ther. 2024 Apr;39(2):173-182. doi: 10.1007/s12928-024-00986-7. Epub 2024 Feb 14.

Authors

Affiliations

¹ Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands.
² Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
³ Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
⁴ Department of Multi-Modality Medical Imaging (M3I) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
⁵ Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands.
⁶ Department of Cardiology, Thoraxcentrum Twente (A25), Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands. e.ploumen@mst.nl.
⁷ Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, The Netherlands. e.ploumen@mst.nl.

Abstract

Patients with peripheral arterial disease (PADs), undergoing percutaneous coronary intervention (PCI), have higher adverse event risks. The effect of invasiveness of PADs treatment on PCI outcome is unknown. This study assessed the impact of the invasiveness of previous PADs treatment (invasive or non-invasive) on event risks after PCI with contemporary drug-eluting stents. This post-hoc analysis pooled 3-year patient-level data of PCI all-comer patients living in the eastern Netherlands, previously treated for PADs. PADs included symptomatic atherosclerotic lesion in the lower or upper extremities; carotid or vertebral arteries; mesenteric arteries or aorta. Invasive PADs treatment comprised endarterectomy, bypass surgery, percutaneous transluminal angioplasty, stenting or amputation; non-invasive treatment consisted of medication and participation in exercise programs. Primary endpoint was (coronary) target vessel failure: composite of cardiac mortality, target vessel-related myocardial infarction, or clinically indicated target vessel revascularization. Of 461 PCI patients with PADs, information on PADs treatment was available in 357 (77.4%) patients; 249 (69.7%) were treated invasively and 108 (30.3%) non-invasively. Baseline and PCI procedural characteristics showed no between-group difference. Invasiveness of PADs treatment was not associated with adverse event risks, including target vessel failure (20.5% vs. 16.0%; HR: 1.30, 95%-CI 0.75-2.26, p = 0.35), major adverse cardiac events (23.3% vs. 20.4%; HR: 1.16, 95%-CI 0.71-1.90, p = 0.55), and all-cause mortality (12.1% vs. 8.3%; HR: 1.48, 95%-CI 0.70-3.13, p = 0.30). In PADs patients participating in PCI trials, we found no significant relation between the invasiveness of previous PADs treatment and 3-year outcome after PCI. Consequently, high-risk PCI patients can be identified by consulting medical records, searching for PADs, irrespective of the invasiveness of PADs treatment.

Keywords: Coronary artery disease; Drug-eluting stent; Percutaneous coronary intervention; Peripheral arterial disease.

MeSH terms

Coronary Artery Disease* / surgery
Humans
Myocardial Infarction* / etiology
Percutaneous Coronary Intervention* / adverse effects
Peripheral Arterial Disease* / complications
Peripheral Arterial Disease* / surgery
Risk Factors
Treatment Outcome